Getting Health Insurance in Uruguay – Part 1

I am happy to report that for the first time in two years, I (Mark) have health insurance, and Lisa Marie has it too for the first time in one year. And it was simple and cheap!

Picture of Asociación Española main hospital in Montevideo
Asociación Española Central Hospital in Montevideo, Uruguay

Technically we have been covered by the ASSE, the Administraciòn de Servicios de Salud del Estado, ever since June when we became eligible for provisional permanent residency. But that is the baseline, mostly poor-people-oriented, part of Uruguay’s three-tier universal health system. We will have another post upcoming that explains more about the different tiers, but for now, we’re covered!

We chose to join one of the larger of the mutualista groups, Asociación Española, at their polyclinic here in Atlántida. In January of this year they opened their first polyclinic in Atlántida, just a few blocks from our home, right on the rambla above the “brave beach” Playa Brava. Also a number of expat forums and blogs had recommended them, such as the Johnson’s posts about choosing them. The price has gone up a bit since they joined in 2008 at 1433 pesos monthly – yesterday Lisa paid $1633 ($ means Pesos in Uruguay, U$S means dollars), and that is without the funeral care supplement that the Johnsons chose – with that it would have been another $143 monthly, $1808 total, or about U$S 93 monthly. A private room supplement is 419 pesos monthly, or a bit under 22 dollars at today’s exchange rate.

We went with the basic plan, at the 1633 UYU (84 dollars USD) monthly. That is what Lisa pays, as she is not “active” in Uruguay – active meaning employed or self-employed (independiente con compañia unipersonal) paying into BPS. BPS is Uruguayan social security system.

Me, I don’t have to pay a peso to Española for my coverage, because I am now an employee of a Uruguayan company. I’ve mentioned on the Facebook & G+ pages for the blog that I now work for a BigCloudSoftwareCompany from Silicon Valley in a RealJob™. But actually I work for a small, maybe 40-person, Uruguayan startup that was building such cool stuff as a value-added partner of the big company that the big company bought them and runs them as a wholly-owned subsidiary. So the Uruguay company still exists, I am an immigrant to Uruguay with residency, working as a uruguayo, for a Uruguayan company. Not an “expat” posted to a “foreign” office. As such, I am enrolled in BPS, the company makes the required BPS contribution including the 6% of gross for medical (something like 4.5% of the negotiated “what you get” net which is how job salaries are defined here unlike USA). All I had to do was give the mutualista my cédula, say I want to enroll through BPS FONASA (The part of BPS that administers health care) and about 5 minutes later I was covered for free, retroactive to the start of November. I didn’t even start my job until Nov 12 and don’t get paid, thus no first contribution, until Nov 30, so that was pretty cool!

If I wanted the private room, the funeral service, or the emergency medical service through separate company SUAT, I would pay the extra fees, but the base membership is through my work, and would be free for any working Uruguayan. Including by law all immigrants permanent or provisionally permanent who are “active”. Spouses of active workers without their own activity are covered for an additional 2% BPS deduction if they have children under 18. As of December 1, concubines (yes that is the term, concubinos/concubinas), domestic partners, I believe of any gender including same-sex partnerships, can be covered under the same arrangements.

This isn’t my political blog, but all in all, the above beats the heck out of “Obamacare”, and the system before the USA’s Patient Protection and Affordable Care Act, the official name of so-called Health Reform. The reason Lisa and I did not have health insurance in USA is because even with 2010-2014 “transitional Obamacare”, you can be excluded for preexisting conditions, any condition at all, from buying individual health insurance, and the state/federal high-risk pools and Obamacare-mandated Preexisting Condition Insurance Plans have premiums of about USD 600/month, with annual deductibles before they pay of 2500 dollars, with then paying only 80% of what they feel is “reasonable and customary”, which they always define as lower than what your doctor or lab actually charges.

Note that nowhere in my description of our sign-up for our mutualista did I mention a health check, a pre-existing condition screening, or premiums based on preexisting conditions. Because none of that happens with this tier of the Uruguay Universal Healthcare System.

Sure, I have to go to their polyclinic. If I joined an HMO in the USA, the popular-in-1990s, now less-so, mode of going only to one network, I would have the same situation. The Mutualista system is much like the medical-home model that the US medical caregivers are starting to support for better health info coordination, and much like one of the two HMO models. That is the model where  HMOs run their own clinics rather than simply being a payment network for private medical practices. The biggest examples of these are Kaiser Permanante in the USA West Coast and Harvard-Pilgrim Health Care in the Massachusetts area.

You cannot believe how relieved I am that we now have health care access. Oh, yes, we do have to pay a copay to see a doctor. $67. That is pesos, remember. About three dollars and fifty cents!

Published by

Mark Mercer

Site co-owner Mark Mercer. AKA Marcos Cristoforo Mercer, AKA the Fuzzy Wanderer. Expat from USA living in Uruguay as of mid-2012, after "test-driving" it for a few months in 2011 and early 2012. Married to Lisamaria, AKA well-known travel and fitness writer Lisa Marie Mercer. Follow Mark on Twitter @mcmxs and his many other sites, which you can find at http://about.me/MarkMercer. I write and engage about many of my other interests, on Google+ at https://google.com/+MarkMercer

9 thoughts on “Getting Health Insurance in Uruguay – Part 1”

  1. Congratulations, Mark! Please keep us posted on the medical information. It's something we have yet to arrange in Panama, where health coverage for us will have to be private.

  2. Congrats on the job and insurance!! My main concern with moving down is not being able to find a job. I am a therapist by trade but I am work in another field as well. I heard there is age discrimination down there when it comes to jobs…

    Thanks!
    Kristina

  3. Mark, you have no idea how your information is making our dream come true. It really helps to know how things will work out for us when we get there. Congratulations to you and Lisa Marie! I do have a question regarding the situation for my husband me. We are both on disability and before your post regarding the banking, I know that we could do our direct deposits to Uruguayan banks. Do you know if this is still the case with the one bank available to US citizens? The 2nd question regards prescriptions. I have read that many medications that require prescriptions in the US, do not in Uruguay, if your meds do require scrips, is this covered with health insurance? And lastly, on average how much is a doctor visit if you have no insurance?

    Again, thank you for all you do for those of us still here that hope to soon be residents Uruguay!
    Alicia

    1. Hi again Alicia, thanks for the nice comments!

      As far as I know, you could never do what is commonly called "direct deposit" in the USA into any Uruguayan bank. "Direct Deposit", of the sort that a US employer, Social Security, Pensions, PayPal, Elance, Google Wallet, and others do, is an Automated Clearing House (ACH) Electronic Funds Transfer (EFT) wholly within the US Banking System via facilities put in place by the Federal Reserve.

      What did happen is that certain of the private banks, like BBVA or IDB, had banks under their same parent companies in the United States, which of course do have regular USA routing numbers and checking account numbers to allow "Direct Deposit" of SSDI or Pension or whatever. Then those banks would do an automatic transfer within the bank holding company from the USA bank to the Uruguayan bank owned by the same company. I don't know if the transfer was really just an international bank wire but automatically initiated, or if it was some other form of subsidiary-to-subsidiary transfer. The end result was what many other expat forums wrongly call "Direct Deposit to a Uruguayan Bank."

      Now, none of those banks will touch American Citizens, not even the USA-owned ones like Citibank, nor the foreign-owned but substantial retail banking presence like Spain's Santander Bank (Sovereign Bank all over New England, about to be rebranded with their global Santander Bank brand just like Santander here in Uruguay.) Discount Bank of Uruguay, a subsidiary of IDB Corporation of New York (Israel Discount Bank) was willing to do it for me in a few years when they heard the amount of what my 2015 age-62 early Social Sec would be (apparently misunderstanding the citizenship issue or thinking I was a non-USA-citizen with USA-legal-resident Social-Security-qualifying earnings.) But once the American Citizen issue pops up, you are out.

      BROU does not do that kind of "quasi direct deposit". The strategy for using BROU is to keep a USA "bank" account – at a bank, a credit union, or some other non-banking bank-like account provider (like my Fidelity Investments MySmartCash Account, now called Cash Management Account). As long as that institution can issue an international bank wire, you are in business…. for a fee, of course. But you need to manage it, though you may be able to create standing instructions with your "bank" to send that wire every month. My credit union, BECU of WA State, has very low-priced wires at $15/wire, no upcharge for international. However they do go through intermediary banks (on inbound international they use evil Bankster Wells Fargo) which I am sure takes its cut, and probably on the outbound too.

      BROU does offer dollar-denominated accounts, so you would probably want a dollar-account with them (U$S 300 min to open, U$S 500 min to avoid charges) for receipt of those funds. You can then transfer freely between the accounts, or use them separately for ATM withdrawals and debit Maestro (a variant of Debit Mastercard) purchases.

    2. Replying separately on the prescriptions issue:

      You have read right. I get my blood pressure meds and Lisa Marie gets some of her meds just by walking into the local farmacia and asking for them. Many drugstores do have a discount of about 20% a "receta", a prescription from a doctor (a medico).

      If your mutualista runs its own pharmacy, as does ours, you get prescriptions for a very low price there, however you have to have a receta from a medico in the practice. I should make an appointment at Española this coming week before I run out of my meds, so that I can get them for about U&S6 instead of the roughly USS16-23 I've been paying at the local pharmacies. Varies by brand and by store. Often there are more than one brand at any given store. It is not exactly "branded vs generic" but rather "competing laboratories".

      I have not seen a doctor here so don't know. Lisa or I may have a link here somewhere from another blog where the blogger had a bad fall and she had to see a doctor without insurance. The whole thing was pretty cheap. I'll see if I can find that.

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